Tripathi Nishant, Koirala Niki, Kato Hirotaka, Singh Tushi, Karri Kishore, Thakur Kshitij
Department of Internal Medicine, University of Kentucky, Lexington, KY, USA.
Department of Clinical Pharmacy, University of Kentucky, Lexington, KY, USA.
Case Rep Gastrointest Med. 2020 Jan 16;2020:4397930. doi: 10.1155/2020/4397930. eCollection 2020.
species (spp.) peritonitis has seldom been identified in medical literature. Scarce cases of peritonitis described previously have been correlated with peritoneal dialysis and more sparingly with spontaneous bacterial peritonitis. exhibits intrinsic and acquired resistance, especially in chronic infections, to most antibiotics. This article conducts a literature review of all previously reported spp. peritonitis and describes the first reported case of peritonitis as a complication of percutaneous endoscopic gastrostomy (PEG) tube placement. peritonitis as a complication of PEG-tube placement has not been previously reported. In our patients' case, the recently placed PEG-tube with ascitic fluid leakage was identified as the most plausible infection source. Although a rare bacterial peritonitis pathogen, may be associated with wide antimicrobial resistance and unfavorable outcomes. No current guidelines provide significant guidance on treatment of PEG-tube peritonitis regardless of microbial etiology. Infectious Disease Society of America identifies various broad-spectrum antibiotics targeting nosocomial intra-abdominal coverage; some of these antimicrobial selections (such as cefepime and metronidazole combination) may yet be inadequate for widely resistant spp. Recognizably, the common antibiotics utilized for spontaneous bacterial peritonitis, i.e., third generation cephalosporins and fluoroquinolones, to which is resistant and variably susceptible, respectively, would be extensively insufficient. Piperacillin/tazobactam (P/T) and carbapenem were identified to provide the most reliable coverage ; clinically, 5 out of the 8 patients who received either P/T or a carbapenem, or both, eventually experienced clinical improvement.
某种（spp.）腹膜炎在医学文献中很少被明确诊断。先前描述的罕见腹膜炎病例与腹膜透析有关，与自发性细菌性腹膜炎的关联则更为少见。该病菌表现出内在和后天获得的耐药性，尤其是在慢性感染中，对大多数抗生素耐药。本文对所有先前报道的spp.腹膜炎进行了文献综述，并描述了首例作为经皮内镜下胃造口术（PEG）置管并发症的spp.腹膜炎病例。此前尚未报道过PEG置管并发症导致的spp.腹膜炎。在我们患者的病例中，最近放置的PEG管伴有腹水渗漏被确定为最可能的感染源。尽管是一种罕见的细菌性腹膜炎病原体，但spp.可能与广泛的抗菌药物耐药性和不良预后相关。目前尚无指南对PEG管相关性腹膜炎的治疗提供重要指导，无论其微生物病因如何。美国传染病学会确定了针对医院内腹腔感染的各种广谱抗生素；其中一些抗菌药物选择（如头孢吡肟和甲硝唑联合使用）可能仍不足以应对广泛耐药的spp.。可以认识到，用于自发性细菌性腹膜炎的常用抗生素，即第三代头孢菌素和氟喹诺酮类，spp.分别对其耐药和敏感性不一，将远远不够。哌拉西林/他唑巴坦（P/T）和碳青霉烯类被确定为提供最可靠的覆盖范围；临床上，8例接受P/T或碳青霉烯类或两者的患者中有5例最终病情得到临床改善。
